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Global Airway Disease Beyond Allergy

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Abstract

Besides the anatomic continuity of the upper and lower airways, inflammation in one part of the airway influences the homeostasis of the other. The mechanisms underlying this interaction have been studied primarily in allergic disease, showing systemic immune activation, induction of inflammation at a distance, and a negative impact of nasal inflammation on bronchial homeostasis. In addition to allergy, other inflammatory conditions of the upper airways are associated with lower airway disease. Rhinosinusitis is frequently associated with asthma and chronic obstructive pulmonary disease. The impairment of purification, humidification, and warming up of the inspired air by the nose in rhinosinusitis may be responsible in part for bronchial pathology. The resolution of sinonasal inflammation via medical and/or surgical treatment is responsible for the beneficial effect of the treatment on bronchial disease. This article provides a comprehensive overview of the current knowledge of upper and lower airway communication beyond allergic disease.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Hens G, Hellings PW: The nose: gatekeeper and trigger of bronchial disease. Rhinology 2006, 44:179–187.

    PubMed  CAS  Google Scholar 

  2. • Hens G, Vanaudenaerde BM, Bullens DM, et al.: Sinonasal pathology in nonallergic asthma and COPD: 'united airway disease' beyond the scope of allergy. Allergy 2008, 63:261–267. This study demonstrated the upper airway involvement with sinonasal symptoms and inflammatory markers in nasal lavages of patients with nonallergic asthma and in those with COPD.

  3. •• Fokkens W, Lund V, Mullol J; European Position Paper on Rhinosinusitis and Nasal Polyps Group: European position paper on rhinosinusitis and nasal polyps 2007. Rhinol Suppl 2007, 20:1-136. This is the state-of-the-art document on rhinosinusitis, including all aspects of the disease from epidemiology to treatment algorithms.

  4. Denburg JA, Keith PK: Systemic aspects of chronic rhinosinusitis. Immunol Allergy Clin North Am 2004, 24:87–102.

    Article  PubMed  Google Scholar 

  5. Bousquet J, Khaltaev N, Cruz AA, et al.: Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy 2008, 63(Suppl 86):8–160.

    Article  PubMed  Google Scholar 

  6. • Bousquet J, Bachert C, Canonica GW, et al.: Unmet needs in severe chronic upper airway disease (SCUAD). J Allergy Clin Immunol 2009, 124:428–433. This review points at the severity of persistent inflammation in the upper airways and unmet needs in the field.

  7. Turner RB: Epidemiology, pathogenesis, and treatment of the common cold. Ann Allergy Asthma Immunol 1997, 78:531–539; quiz 539–540.

    Google Scholar 

  8. Johnston SL, Pattemore PK, Sanderson G, et al.: Community study of role of viral infections in exacerbations of asthma in 9-11 year old children. BMJ 1995, 310:1225–1229.

    PubMed  CAS  Google Scholar 

  9. Grunberg K, Timmers MC, de Klerk EP, et al.: Experimental rhinovirus 16 infection causes variable airway obstruction in subjects with atopic asthma. Am J Respir Crit Care Med 1999, 160:1375–1380.

    PubMed  CAS  Google Scholar 

  10. Lemanske RF Jr, Dick EC, Swenson CA, et al.: Rhinovirus upper respiratory infection increases airway hyperreactivity and late asthmatic reactions. J Clin Invest 1989, 83:1–10.

    Article  PubMed  Google Scholar 

  11. Seemungal T, Harper-Owen R, Bhowmik A, et al.: Respiratory viruses, symptoms, and inflammatory markers in acute exacerbations and stable chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2001, 164:1618–1623.

    PubMed  CAS  Google Scholar 

  12. Papadopoulos NG, Bates PJ, Bardin PG, et al.: Rhinoviruses infect the lower airways. J Infect Dis 2000, 181:1875–1884.

    Article  PubMed  CAS  Google Scholar 

  13. Mosser AG, Vrtis R, Burchell L, et al.: Quantitative and qualitative analysis of rhinovirus infection in bronchial tissues. Am J Respir Crit Care Med 2005, 171:645–651.

    Article  PubMed  Google Scholar 

  14. Gern JE: Rhinovirus respiratory infections and asthma. Am J Med 2002, 112(Suppl 6A):19 S–27S.

    Google Scholar 

  15. Avila PC, Abisheganaden JA, Wong H, et al.: Effects of allergic inflammation of the nasal mucosa on the severity of rhinovirus 16 cold. J Allergy Clin Immunol 2000, 105:923–932.

    Article  PubMed  CAS  Google Scholar 

  16. Edwards MR, Kebadze T, Johnson MW, Johnston SL: New treatment regimens for virus-induced exacerbations of asthma. Pulm Pharmacol Ther 2006, 19:320–334.

    Article  PubMed  CAS  Google Scholar 

  17. Bousquet PJ, Leynaert B, Neukirch F, et al.: Geographical distribution of atopic rhinitis in the European Community Respiratory Health Survey I. Allergy 2008, 63:1301–1309.

    Article  PubMed  Google Scholar 

  18. •• Rondon C, Romero JJ, Lopez S, et al.: Local IgE production and positive nasal provocation test in patients with persistent nonallergic rhinitis. J Allergy Clin Immunol 2007, 119:899–905. This was an innovative study of the presence of local IgE and positive nasal allergen provocation in patients with suspicion of allergic rhinitis and negative skin prick test.

  19. Ponikau JU, Sherris DA, Kephart GM, et al.: Features of airway remodeling and eosinophilic inflammation in chronic rhinosinusitis: is the histopathology similar to asthma? J Allergy Clin Immunol 2003, 112:877–882.

    Article  PubMed  Google Scholar 

  20. Ragab A, Clement P, Vincken W: Correlation between the cytology of the nasal middle meatus and BAL in chronic rhinosinusitis. Rhinology 2005, 43:11–17.

    PubMed  Google Scholar 

  21. Hellings PW, Hens G, Meyts I, et al.: Aggravation of bronchial eosinophilia in mice by nasal and bronchial exposure to Staphylococcus aureus enterotoxin B. Clin Exp Allergy 2006, 36:1063–1071.

    Article  PubMed  CAS  Google Scholar 

  22. Senior BA, Kennedy DW, Tanabodee J, et al.: Long-term impact of functional endoscopic sinus surgery on asthma. Otolaryngol Head Neck Surg 1999, 121:66–68.

    Article  PubMed  CAS  Google Scholar 

  23. Manning SC, Wasserman RL, Silver R, et al.: Results of endoscopic sinus surgery in pediatric patients with chronic sinusitis and asthma. Arch Otolaryngol Head Neck Surg 1994, 120:1142–1145.

    PubMed  CAS  Google Scholar 

  24. Schaitkin B, May M, Shapiro A, et al.: Endoscopic sinus surgery: 4-year follow-up on the first 100 patients. Laryngoscope 1993, 103:1117–1120.

    Article  PubMed  CAS  Google Scholar 

  25. Kennedy DW: Prognostic factors, outcomes and staging in ethmoid sinus surgery. Laryngoscope 1992, 102:1–18.

    PubMed  CAS  Google Scholar 

  26. Ragab S, Scadding GK, Lund VJ, Saleh H: Treatment of chronic rhinosinusitis and its effects on asthma. Eur Respir J 2006, 28:68–74.

    Article  PubMed  CAS  Google Scholar 

  27. Van Zele T, Gevaert P, Watelet JB, et al.: Staphylococcus aureus colonization and IgE antibody formation to enterotoxins is increased in nasal polyposis. J Allergy Clin Immunol 2004, 114:981–983.

    Article  PubMed  CAS  Google Scholar 

  28. Ponikau JU, Sherris DA, Kephart GM, et al.: The role of ubiquitous airborne fungi in chronic rhinosinusitis. Curr Allergy Asthma Rep 2005, 5:472–476.

    Article  PubMed  Google Scholar 

  29. Batra PS, Kern RC, Tripathi A, et al.: Outcome analysis of endoscopic sinus surgery in patients with nasal polyps and asthma. Laryngoscope 2003, 113:1703–1706.

    Article  PubMed  Google Scholar 

  30. •• Guilemany JM, Angrill J, Alobid I, et al.: United airways again: high prevalence of rhinosinusitis and nasal polyps in bronchiectasis. Allergy 2009, 64:790–797. This was a unique study on the association of sinus disease with bronchiectasis.

  31. Braunstahl GJ, Hellings PW: Nasobronchial interaction mechanisms in allergic airways disease. Curr Opin Otolaryngol Head Neck Surg 2006, 14:176–182.

    Article  PubMed  Google Scholar 

  32. Scadding G: Nitric oxide in the airways. Curr Opin Otolaryngol Head Neck Surg 2007, 15:258–263.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Otorhinolaryngology, Head, and Neck Surgery, University Hospitals Leuven, Kapucijnenvoer 33, Leuven, 3000, Belgium

    Peter W. Hellings

  2. Department of Otorhinolaryngology, Head, and Neck Surgery, University of Crete School of Medicine, Heraklion, Crete, Greece

    Emmanuel P. Prokopakis

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  1. Peter W. Hellings
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Correspondence to Peter W. Hellings.

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Hellings, P.W., Prokopakis, E.P. Global Airway Disease Beyond Allergy. Curr Allergy Asthma Rep 10, 143–149 (2010). https://doi.org/10.1007/s11882-010-0107-1

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